Sex Differences in Cardiac Remodeling after Kidney Transplantation

Sex Differences in Cardiac Remodeling after Kidney Transplantation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sex Differences in Cardiac Remodeling after Kidney Transplantation Oscar Orihuela Rodríguez, Hector A Carmona-Ruiz, Ramon Espinoza Pérez, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5074289/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Aug, 2025 Read the published version in BMC Nephrology → Version 1 posted 15 You are reading this latest preprint version Abstract Background: Cardiovascular diseases are the most frequent causes of death in patients with chronic kidney disease. Patients with chronic kidney disease have heart remodeling manifested by left ventricular hypertrophy , left atrial enlargement, diastolic and systolic dysfunction. After kidney transplantation there is reverse remodeling of the changes. Male and female hormones modify this remodeling. The aim of the study is to know the remodeling changes of the heart after kidney transplant according to the sex. Methods: A prospective study was carried out with follow-up at 3 and 6 months, included patients in the kidney transplant protocol sent to the Cardiology service to those who underwent an echocardiogram and laboratory shots before the kidney transplantation and after 3 and 6 months. Statistical analysis: The patients were categorized according to sex as well as the follow-up of the echocardiographic parameters . The comparison of the different echocardiographic parameters was performed an analysis of variance of two factors (ANOVA) considering one sex factor and the other the follow-up time. A value of p< 0.05 was considered significant. Results: A total of 51 patients were studied, 19 women and 32 men (mean age of 31.16±9.83 vs 31.66± 9.63); p 0.86) years. The Left ventricular hypertrophy showed differences according to sex from baseline being higher in men with left ventricular mass index (LVMI) compared to women ( male 152.94±58.24 Vs women 103.89±29.94 g /m 2 .; p=0.000) and at follow-up men presented a greater reduction in LVMI compared to women (p=0.000). The left atrial volume index was found to be langer at baseline in women compared to men (LAVI 45.18±29.77 Vs. 29.05± 9.30ml/m 2 .;p=0.028) at follow-up the size reduction was significantly greater in women (p = 0.012 and according to follow-up p = 0.000). Conclusion: If there is a difference in remodeling , it reverses according to sex in the echocardiographic parameters. Sex differences Cardiac remodeling Kidney transplant Figures Figure 1 Figure 2 Background Cardiovascular disease is the most common cause of morbidity and mortality in patients with chronic kidney disease (CKD)(1; 2). The heart undergoes adaptive structural changes due to increased work overload known as cardiac remodeling ( 3 ). The most important manifestation is left ventricle hypertrophy (LVH) cardinal point of uremic cardiomyopathy histologically found the presence of severe myocyte hypertrophy with myocardial disorder and diffuse interstitial fibrosis., another form of presentation is systolic dysfunction (DS) or diastolic dysfunction (DD). At the level of the left atrium there is growth with structural and electrical remodeling as part of uremic cardiomyopathy ( 4 – 6 ). The hypertrophy of the left ventricle is different according to sex, the response of the heart to pressure overload in women by estrogen-specific B receptors present left ventricular hypertrophy with diastolic dysfunction and in men present eccentric hypertrophy with deterioration of systolic function. Women have a lower degree of apoptosis fibrosis compared to men ( 7 – 10 ). The restoration of renal function associated with kidney transplantation (KT) leads to a homeostasis of hormonal, hemodynamic factors that modify the shape and size of the chambers of the heart, causing reverse remodeling of LVH and left atrium with improvement of systolic and diastolic function ( 3 , 11 ). The main objective of the study is to know the changes in LVH, left auricula and diastolic function according to sex after kidney transplantation. Material and Method Design: It was a prospective study with follow-up at 3 and 6 months. The participating patients were sent to the Cardiology service by renal transplant service. The protocol was approved by the ethics and research committee of the Hospital of specialties of the National Medical Center XXI century of the Mexican Institute of Social Security (number R-2016-3601-203 ) were entered into the protocol with prior signature of the informed consent by each participant. The study was conducted from February 2018 to January 2020.The participants in the study were patients with chronic kidney disease who met the following inclusion criteria: a) Patient with chronic renal failure of any etiology with previous echocardiogram and with echocardiographic follow-up at 3 and 6 months after living donor kidney transplantation, (b) Any age and sex; c) Patient with CKD with or without replacement therapy undergoing living donor kidney transplantation; d) Patient with CKD who has levels of Hb, Hto, Ca. P, PTH prior to transplantation and after transplantation living donor. The exclusion criteria were a) Patient with previous heart disease presenting cardiac hypertrophy or fibrosis, b) previous kidney transplant; c) evidence of cancer, seropositive for hepatitis B, hepatitis C, or HIV. Echocardiogram: The echocardiographic evaluation was performed using the commercially available echocardiogram iEE33 (Phillips Medical System. Andaver. MA) The 2D images, M mode were obtained in a long, short and apical parasternal axis with the patient in the position of left lateral decubitus, the measurements were made according to the recommendations of the American Society of Echocardiography ( 12 ).( 12 ) The left ventricle mass (LVM) was calculated according to Deveraux's formula, left ventricle hypertrophy was defined if it is equal to or greater than 95 g / m 2 in women and 115g / m 2 in men ( 13 ). Body surface area was calculated using Mosteller's formula ( 14 ). Diastolic function was evaluated following the recommendations of the American Society of Echocardiography which considers diastolic dysfunction if it meets 3 or more of the following criteria: Ratio e/e ́> 14m e'septal velocity < 7cm/sec or lateral e'lateral velocity 2.8m/sec, volume index to left auricula > 34ml/m 2 b.s. (15). Biochemical measurements: A sample of venous blood was obtained from the antecubital vein and taken in the morning after 12hrs of fasting. The samples were centrifuged and stored plasma and sounded in aliquots at – 70°C using test tubes. Glucose, urea, creatinine, albumin, calcium and phosphorus were measured by standard automated method. Statistical analysis: The quantitative variables were reported as mean (SD) or median and quatile according to the distribution (25.75 quartiles). Qualitative variables were reported in frequency and percentages. The patients were categorized according to sex as well as the follow-up of the echocardiographic parameters. The comparison of the different echocardiographic parameters was performed an analysis of variance of two factors (ANOVA) considering one sex factor and the other the follow-up time. A value of p < 0.05 was considered significant. Data were analyzed using SPSS 22.0 software (IBM Corp. USA). RESULTS A total of 51 patients were studied and a living donor kidney transplant was performed with a follow-up at 3 and 6 months respectively. There were 19 women and 32 men (mean age 31.16 ± 9.83 vs 31.66 ± 9.63;p 0.86) years; The cause of renal failure was mainly glomerulonephritis in 23 (45.09%), hypertension 2, diabetic nephropathy 2, other causes in 8 and 16 without knowing the cause and there was no difference between sex. The most frequent co-morbidity found was systemic arterial hypertension in 43 (84.3%) of the total population studied, the most frequent replacement treatment was automated peritoneal dialysis in 21 patients, however there were 4 patients without replacement therapy. (Table 1 ). Table 1 Comorbidities, Causes of kidney disease, Dialysis method and pharmacotherapy. Female (n 19) Male(n 32) P value Comorbidities : Hypertension (y/n) 15/4 28/4 0.417 DM (y/n) 2/17 3/29 0.894 Dyslipidemia (y/n) 9/10 14/18 0.802 Smoking (y/n) 4/15 12/20 0.221 Causal neprhropathy : Glomerulonephritis 7 16 0.050* Hypertension 1 1 Diabetic Nephropathy 0 2 Other 5 3 0.050* Unknown 11 5 0.000* Dyalysis method (y/n) 17/2 30/2 Conservative treatment 2 2 0.040* APD 6 15 0.000* CAPD 6 6 0.040* Hemodialysis 5 7 0.001 Antihypertensive medication (y/n) 16/3 27/5 0.988 Beta-blocker (y/n) 2/17 5/29 0.690 ACE inhibitors (y/n) 2/17 3/29 0.894 Angiotensin receptor blockers(y/n) 10/9 22/10 0.250 Calcium-channel blockers (y/n) 9/10 18/14 0.5 39 Others (y/n) 4/15 12/20 0.221 APD, Automated Peritoneal Dialysis: CADP, Continuous Ambulatory Peritoneal Dialysis Baseline cardiovascular parameters were observed higher weight, body surface area, as well as systolic and diastolic pressure in men compared to women with significant difference. There was no significant difference between sex in baseline biochemical parameters. (Table 2 ). Table 2 Variables laboratory and cardiovascular at baseline Variable Female (19) Male (32) P Age (years) 31.16 ± 9.84 31.66 ± 9.63 0.860 Weight (kilos) 57.91 ± 11.52 67.54 ± 19.54 0.018* Size (meters) 1. 57 ± 0.08 1.67 ± 0.08 0.000* BMI (kg/m 2 b.s.) 23.30 ± 3.97 23.90 ± 3.95 0.604 Body surface (m 2 ) 1.57 ± 0.17 1.75 ± 0.20 0.002* Systolic pressure (mmHg) 116.37 ± 19.93 130.31 ± 19.21 0.016* Diastolic pressure (mmHg) 76.95 ± 10.58 85.06 ± 14.48 0.039* Pulse pressure 39.42 ± 13.04 42.25 ± 13.40 0.136 Creatinine clearance (mg/dl) 11.36 ± 4.04 12.59 ± 5.44 0.399 Urea clearance (mg/dl) 140.71 ± 38.39 131.47 ± 55.37 0.525 Glucose (mg/dl) 90.68 ± 14.42 131.63 ± 161.91 0.279 Hb (gr/dl) 10.5 ± 1.66 10.44 ± 2.41 0.485 Hto (%) 31.20 ± 5.34 31.71 ± 7.06 0.787 Cholesterol (mg/dl) 173.11 ± 38.38 166.99 ± 40.07 0.592 Triglycerides (mg/dl) 165.00 ± 86.27 164.96 ± 219.95 0.999 Albumin (mg/dl) 4.14 ± 0.63 4.10 ± 0.59 0.856 Phosphorus (mg/dl) 5.90 ± 1.75 5.94 ± 1.81 0.915 Calcium (mg/dl) 8.99 ± 0.77 9.17 ± 1.79 0.072 Sodium (mEq/L) 137.56 ± 3.31 137.62 ± 5.58 0.968 Potassium (mEq/L) 4.97 ± 1.01 4.87 ± 1.05 0.751 BMI, body mass index;Hb, Hemoglobin; Hto; Hematocrit Analysis of biochemical and echocardiographic changes during follow-up according to sex. A significant increase in hemoglobin, albumin, and sodium levels is observed predominantly in men from 3 months to 6 months. (Fig. 1 A, 1 B, 1 E); Likewise, a significant decrease is observed according to the follow-up in the levels of urea, creatinine, phosphorus, potassium without any difference according to sex. (Fig. 1 C, 1 D, 1 F, 1 G). The increase in calcium levels was observed in both sexes without significant difference (Fig. 1 F). The IMVI there was a difference according to gender at baseline finding higher LVMI in men compared to women (IMVI man 152.94 ± 58.24 Vs women 103.89 ± 29.94 g / m 2 b.s.; p = 0.000) and in the follow-up a significant decrease in IMVI was observed more in men than in women with statistically significant differences. (Fig. 2 A) The left auricula was larger in women at baseline compared to men ( LAVI 45.18 ± 29.77 Vs. 29.05 ± 9.30 ml / m 2 b.s. ) A reduction in size at the end of follow-up showed a significant difference according to sex p = 0.012 and according to follow-up p = 0.000. (Fig. 2 B) The parameters of systolic function there was improvement of the fraction of expulsion in men without significant differences with women in the follow-up (p 0.008). (Fig. 2 C) The diastolic diameters were increased in the baseline state in men which a significant decrease was observed at three months with significant difference and in the end there was no difference. (Fig. 2 D). LV diastolic function was estimated according to the parameters previously described. A total of 38 patients presented at baseline diastolic dysfunction (16 women vs 22 men) at follow-up it was observed that diastolic dysfunction decreased to 30 (9 women and 21 men) (p 0.008). The right ventricle its diameters were within normal limits although there was a significant difference according to sex being greater in men in the basal, middle and longitudinal diameters as well as the area of the right auricula with statistically significant differences compared to women. (Fig. 2 D, 2 E). Discussion The findings of this study show significant differences in LVH, systolic and diastolic function according to sex in patients with CKD before transplantation. In addition, a different pattern of reverse remodeling of the left ventricle in patients with CKD after kidney transplantation in men and women was pointed out without previous knowledge of this phenomenon. Physiology and cardiovascular diseases are influenced by sex. Among the explanations for these differences, one of the most accepted is the effect of sex steroids. While estrogens have anti-inflammatory and cardioprotective effects in premenopausal women, testosterone has been found to induce abnormal cardiac remodeling in men ( 16 , 17 ). These characteristics explain why chronic diseases such as hypertension, cardiovascular disease, diabetes, and obesity occur earlier and are more severe in men (18, 19, 20, 21, ). However, lifestyle factors such as unhealthy diets, smoking, alcoholism, and a sedentary lifestyle are more common in men ( 22 ) and may contribute to the differences. Differences by sex are also noted in CKD patients. Interestingly, women have a higher prevalence of CKD than men ( 23 ) but all-cause mortality, particularly cardiovascular mortality, is higher in men ( 24 ). The effect of sex hormones on the progression of CKD is inconsistent. In an analysis of the CRIC study with almost four thousand patients, there was no difference by sex in the loss of eGFR after adjusting for some variables ( 25 ). In various studies, CKD progression was faster in men, although it was associated with higher proteinuria ( 26 ). Some studies have shown higher mortality in women than in men in the population receiving hemodialysis, but the increase in mortality was related to diabetes ( 27 ). Other studies in the Hemodialysis population have shown contrary data, with more remarkable survival in women than in men.( 28 ). The data from the European registry do not show differences in cardiovascular mortality by gender in the dialysis population ( 29 ). Improving cardiovascular changes after renal transplantation is multifactorial; it includes reducing fluid overload, hemodynamic changes, the elimination of uremic toxins, and decreasing inflammation ( 30 ) . The reduction of LVH after kidney transplantation is secondary to a significant decrease in fluid overload and uremic toxicity due to the proper functioning of the graft that favors the elimination of intravascular water and, consequently, reduction of the activity of the sympathetic nervous system with the decrease of catecholamines. On the other hand, the calcium by phosphorus product after kidney transplantation is modified, observing a significant decrease in phosphorus and improvement of calcium levels with ( 31 , 32 , 33 ), decrease in parathyroid hormone and secondarily aldosterone levels that favor the decrease of LVH and myocardial fibrosis due to apoptosis as described when performing parathyroidectomy ( 34 ). These changes are evident after six months of transplantation due to the recovery of function in both sexes ( 35 , 36 ). The magnitude of LVH reduction is variable ( 37 – 42 ). Iqbal et al. reported that in 22 patients, the most significant decrease in LVMI was 131g/m2 at a 3-month follow-up( 43 ). However, there are studies whit no significant changes in the LVMI ( 44 , 45 ) In all these studies, difference by sex was not reported. In our study, men had a reduction in LVMI of 36.68g/m2 of surface area at six months, more considerable than observed in women, which was 17.87g/m2 (p 0.000). The reduction in LVMI is lower than that reported by Iqbal et al. since LVMI at baseline was 379g/m2 in their population, more extensive compared to our population, where the IMV did not was so important. The ejection fraction is a parameter to assess systolic function. It is reported in the literature that there are changes in ejection fraction after transplantation when evaluation is performed by echocardiography and magnetic resonance imaging. Deng et al. ( 46 ) reported that in 48 patients with baseline EF from 40 ( 11 ) %, it increased to 60 ( 14 ) %; (p < 0.05). In our study EF was within normal limits from baseline; however, it was higher in women (64.47(7.23) vs. men 54.54(11.53), and an additional improvement was observed in the male group (FE 61.57(9.98; p 0.008) during follow-up. Post-transplant left ventricular end-diastolic diameters (LVDD) decreased, probably secondary to reduced intravascular volume and blood pressure, lower angiotensin levels, and sympathetic activity. There are controversial studies in this regard. Non-significant differences were found in some reports; however, when the evaluation was done with magnetic resonance, they became significant ( 46 ). In the post-transplant follow-up, we found a decrease in it, being more evident in men (initial LVDD from 48.47 (8.79) decreased to 41.80 (7.74), p 0.007). Zapolski et al. ( 47 ) reported a decrease in the hemodynamic indices of the left auricula at three and six months of post-renal transplant follow-up. LAVI is a marker of diastolic dysfunction and remodeling. It changed secondary to improvement in diastolic function after transplantation ( 48 ). In our study, we observed that LAVI at baseline was higher in women than in men 81(29.87) Vs. 29.05(9.30ml/m2) with more significant diastolic dysfunction in women. During follow-up, the decrease in LAVI was more significant at three months. At the end of the follow-up, it was within normal limits. Insufficiency-type dysfunction is the most common finding in the heart valves. It improves after transplantation, as was previously reported in a study in 59 valves; the order of frequency of the valves affected was: tricuspid 28, mitral 21, aortic 5, and pulmonary 4, respectively. At the end of the follow-up, it decreased to 40. The most frequent were mitral and tricuspid ( 49 , 50 ). Recently, a close interaction of sex hormones with intestinal microbiota on CKD patients' cardiovascular system deterioration has been described. The effect on cardiac architecture is more accentuated in men than women ( 51 ) and is related to disturbances of extracellular matrix homeostasis. Gut microbiota seems to have participation in posttransplant outcomes; however, its specific effects on cardiovascular changes after transplantation are not known ( 52 ). The most important findings of our study are the difference in reverse change of heart remodelation according to sex in patients with CKD after kidney transplantation. At baseline, a lower degree of LVH but more significant diastolic dysfunction and dilation of the left atrium were seen in women. After transplantation, remodeling of the left atrium was also more significant in women. In contrast, reverse remodeling of the left ventricle with decreased LVMI, diastolic diameters, and improvement of EF was more significant in men. Our study has some limitations. The follow-up was limited to early changes; more evident results could be obtained with a follow-up longer than 24 months. However, due to the pandemic, it was burdensome to follow up with patients due to the risk of infection during the cardiological assessment. Likewise, another limitation is the follow-up of cardiac remodeling only by echocardiography. Ideally, MRI study with gadolinium should be used; however, subjecting post-transplant patients to this type of study has the risk of toxicity, causing undesirable graft dysfunction, which is why it is not recommended at least a specific indication by heart disease. In conclusion, we found differences in inverse remodeling of the heart of post-transplanted patients according to their sex. This included hypertrophy of the left ventricle and the left auricula with the decrease of the IMVI, the size of the left atrium, and modification of the diastolic function. Abbreviations LVH. Left Ventricular Hypertrophy KT Kidney Transplantation LVMI Left Ventricular Mass Index LAVI Left Atrial Volumen Index CKD Chronic Kidney Disease DS Systolic Dysfunction DD. Diastolic Dysfunction PTH Parathyroid Hormone HIV Human immunodeficiency virus SD Standart Deviation ANOVA Analysis of Variance GFR Glomerular Filtration Rate EF Ejection Fraction LVDD Left Ventricular Diastolic Diameters MRI Magnetic Resonance Image APD Automated Peritoneal Dialysis CAPD Continuous Ambulatory Peritoneal Dialysis BMI Body Mass Index Hb Hemoglobin Hto. Hematocrit Declarations Acknowledgements : The authors would like to thank the electrocardiograph technician and the nursing staff for their support in carrying out this study. Author Contributions : OOR, HCR and RPS conceived the study. OOR, CBM. IMG, RGL, and IQO examined patients and collected patient data. OOR, HCR, REP, JCL and RPS did data analyses. OOR did the statistical analysis. OOR, and RPS wrote the first draft.RPS and OOR revised the manuscript providing critical inputs. AS finalized the manuscript. All authors reviewed and agreed on the finalized manuscript. Funding The authors did not receive any type of funding for this study. Available of Data and Materials : The data may be made on a reasonable request. Conflict of Interest None. Ethical Approval and Consent to Participate : The protocol was approved by the ethics in accordance with the Declaration of Helsinki and research committee of the Hospital of specialties of the National Medical Center XXI century of the Mexican Institute of Social Security (number R-2016-3601-203 ) were entered into the protocol with prior signature of the informed consent by each participant. References Koo TY, Ahn C, Yang J..Renal Allograft Function Is a Risk Factor of Left Ventricular Remodeling After Kidney Transplantation., Transplant Proc. 2017;49(5): 1043-1047. doi: 10.1016/j.transproceed.2017.03.052. 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Soraia R C Ferreira , Valdir A Moisés, Agostinho Tavares, et al.Cardiovascular effects of successful renal transplantation: a 1-year sequential study of left ventricular morphology and function, and 24-hour blood pressure profile. Transplantation 2002;74(11): 1580-1587. doi: 10.1097/00007890-200212150-00016. Sahand Hamidi , Javad Kojuri , Armin Attar,et al.The effect of kidney transplantation on speckled tracking echocardiography findings in patients on hemodialysis. J Cardiovasc Thorac Res 2018;10(2): 90-94. doi: 10.15171/jcvtr.2018.14. Bernd Hewing , Anna Maria Dehn, Oliver Staeck, et al Improved Left Ventricular Structure and Function After Successful Kidney Transplantation. Kidney Blood Press Res 2016;41(5): 701-709. doi: 10.1159/000450559. qbal MM, Rashid HU, Banerjee SK, et al. Changes in cardiac parameters of renal allograft recipients: a compilation of clinical, laboratory, and echocardiographic observations., Transplant Proc 2008;40(7): 2327-2329. doi: 10.1016/j.transproceed.2008.07.099. Stewart GA, Foster J, Cowan M, et al. Echocardiography overesti-mates left ventricular mass in hemodial-ysis patients relative to magneticresonance imaging. Kidney Int 1999; 256(6):248 - 2253. doi: 10.1046/j.1523-1755.1999.00786.x. Hawwa N, Schreiber MJ Jr, Tang WH Pharmacologic management of chronic reno-cardiac syndrome.. Curr Heart Fail Rep 2013;10(1): 54-62. doi: 10.1007/s11897-012-0122-8. Deng Y, Pandit A, Heilman RL, et al.Left ventricular torsion changes post kidney transplantation. J Cardiovasc Ultrasound 2013;21(4): 171-176. doi: 10.4250/jcu.2013.21.4.171. Zapolski T, Furmaga J, Wysokiński AP, et al.The atrial uremic cardiomyopathy regression in patients after kidney transplantation - the prospective echocardiographic study. BMC Nephrology 2019;20(1): 152. doi: 10.1186/s12882-019-1333-y. Mats Christian Højbjerg Lassen, Atif Qasim , Allison Webber , et al.The effect of kidney transplantation on left ventricular remodeling and global diastolic strain rate in end-stage renal disease. Echocardiography 2021;38(11); 1879-1886. doi: 10.1111/echo.15226. Melchor JL, Gracida C, Orihuela O. Improvement of Mitral Dysfunction After Kidney Transplantation. Transplant Proc 2002;34(1): 396-397. doi: 10.1016/s0041-1345(01)02837-8. Garcia-Covarrubias L, Hernández K, Castro I, Hinojosa H, Molina L, et al.Cardiac Remodeling in Structure and Function Six Months After Kidney. Transplat Proc 2018;50(2): 254-257. doi: 10.1016/j.transproceed.2017.12.038. Kararigas S, Li G . Role of Biological Sex in the Cardiovascular-Gut Microbiome Axis. Front Cardiovascular Med 2022;3: 759735. doi: 10.3389/fcvm.2021.759735 Winichakoon P, Chaiwarith R, Chattipakorn N, Chattipakorn SC. Impact of gut microbiota on kidney transplantation. Transplant Rev (Orlando). 2022 ;36(1):100668. doi: 10.1016/j.trre.2021.100668. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Aug, 2025 Read the published version in BMC Nephrology → Version 1 posted Editorial decision: Revision requested 18 Nov, 2024 Reviews received at journal 17 Nov, 2024 Reviews received at journal 16 Nov, 2024 Reviews received at journal 06 Nov, 2024 Reviews received at journal 02 Nov, 2024 Reviewers agreed at journal 02 Nov, 2024 Reviewers agreed at journal 29 Oct, 2024 Reviewers agreed at journal 27 Oct, 2024 Reviewers agreed at journal 27 Oct, 2024 Reviewers agreed at journal 26 Oct, 2024 Reviewers invited by journal 26 Oct, 2024 Editor invited by journal 01 Oct, 2024 Editor assigned by journal 01 Oct, 2024 Submission checks completed at journal 01 Oct, 2024 First submitted to journal 11 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5074289","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":380196084,"identity":"f9b897dc-8dda-4ff8-a6de-6ea946612c6b","order_by":0,"name":"Oscar Orihuela Rodríguez","email":"","orcid":"","institution":"Departamento Clinico de Cardiología, UMAE H. de Especialidades del Centro Medico Nacional Siglo XXI","correspondingAuthor":false,"prefix":"","firstName":"Oscar","middleName":"Orihuela","lastName":"Rodríguez","suffix":""},{"id":380196085,"identity":"03a7bf51-4858-4d0f-b968-9c2756458b4a","order_by":1,"name":"Hector A Carmona-Ruiz","email":"","orcid":"","institution":"Departamento Clinico de Cardiología, UMAE H. de Especialidades del Centro Medico Nacional Siglo XXI","correspondingAuthor":false,"prefix":"","firstName":"Hector","middleName":"A","lastName":"Carmona-Ruiz","suffix":""},{"id":380196086,"identity":"3cd660f3-b18f-4758-aa5e-52b0331dc89d","order_by":2,"name":"Ramon Espinoza Pérez","email":"","orcid":"","institution":"Unidad de Transplante Renal, UMAE H. de Especialidades del centro Médico Nacional Siglo XXI","correspondingAuthor":false,"prefix":"","firstName":"Ramon","middleName":"Espinoza","lastName":"Pérez","suffix":""},{"id":380196087,"identity":"fb31abd9-0e78-4585-b16a-b8121d0b3dfd","order_by":3,"name":"Jorge Cancino López","email":"","orcid":"","institution":"Unidad de Transplante Renal, UMAE H. de Especialidades del centro Médico Nacional Siglo XXI","correspondingAuthor":false,"prefix":"","firstName":"Jorge","middleName":"Cancino","lastName":"López","suffix":""},{"id":380196088,"identity":"7d3799f5-ff8f-467f-8e71-dec4da8c916a","order_by":4,"name":"Carlos Blanco Mendez","email":"","orcid":"","institution":"Departamento Clinico de Cardiología, UMAE H. de Especialidades del Centro Medico Nacional Siglo XXI","correspondingAuthor":false,"prefix":"","firstName":"Carlos","middleName":"Blanco","lastName":"Mendez","suffix":""},{"id":380196089,"identity":"36b3732f-899c-487e-875a-e9eb87696b49","order_by":5,"name":"Ian Morales Gudiño","email":"","orcid":"","institution":"Departamento Clinico de Cardiología, UMAE H. de Especialidades del Centro Medico Nacional Siglo XXI","correspondingAuthor":false,"prefix":"","firstName":"Ian","middleName":"Morales","lastName":"Gudiño","suffix":""},{"id":380196090,"identity":"130f8d18-a9d6-4591-8466-3afb92caf40e","order_by":6,"name":"Raquel A Gonzalez López","email":"","orcid":"","institution":"Departamento Clinico de Cardiología, UMAE H. de Especialidades del Centro Medico Nacional Siglo XXI","correspondingAuthor":false,"prefix":"","firstName":"Raquel","middleName":"A Gonzalez","lastName":"López","suffix":""},{"id":380196091,"identity":"123f86cf-f2bc-440e-914a-c3f94e36cd6c","order_by":7,"name":"Itzel Quiñonez Orihuela","email":"","orcid":"","institution":"Departamento Clinico de Cardiología, UMAE H. de Especialidades del Centro Medico Nacional Siglo XXI","correspondingAuthor":false,"prefix":"","firstName":"Itzel","middleName":"Quiñonez","lastName":"Orihuela","suffix":""},{"id":380196092,"identity":"ab83a310-bbd8-444c-9405-add04d38b852","order_by":8,"name":"Ramon Paniagua Sierra","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBACxgYQaQBhPwASPHykaGEGUTxspNjIJgEmCSljnn324OeCAju7DcePP6v8mmMnw8bA/PDRDXwO68tLlp5hkJy84UyO2W3ZbclAh7EZG+fg09LDYyDNY8CcbHAgh+225DZmoBYeNmkCWox/8xjUJxucf/6sWHJbPVFazIC2HLYzuJFgxvhx22FitPClWfMYHE+QvPHGWJpx23EeNmYCfjHs4T18m+dPtT3f+fSHH39uq7bnZ29++BivlgYeMJ3YACSYwWxmPMpBQJ4BosUe7MofBFSPglEwCkbByAQAw4BCUp+AcxEAAAAASUVORK5CYII=","orcid":"","institution":"Unidad de Investigación en Enfermedades Nefrológicas. UMAE H. de Especialidades del Centro Médico Nacional Siglo XXI, instituto Mexicano del Seguro Social, Unidad de Investigación en Enfermedades Nefrológicas","correspondingAuthor":true,"prefix":"","firstName":"Ramon","middleName":"Paniagua","lastName":"Sierra","suffix":""}],"badges":[],"createdAt":"2024-09-12 02:55:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5074289/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5074289/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12882-025-04313-x","type":"published","date":"2025-08-06T15:56:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79321012,"identity":"d6a48299-798d-4f14-b367-914340499dce","added_by":"auto","created_at":"2025-03-27 04:29:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":366593,"visible":true,"origin":"","legend":"\u003cp\u003eBiochemical variables are show by sex kidney pos- transplant.\u003c/p\u003e\n\u003cp\u003e(A,B,E) Increased hemoglobin , albumin and sodium levels were more significant in men after transplantation. (C,D,F,G ) decreased levels of creatinine, urea, potassium and phosphorous without significant differences according to sex after kidney transplant\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5074289/v1/fd6c203d85e2f7d79a7b9084.png"},{"id":79321013,"identity":"744f68ac-8d8a-4f56-8572-8f1641f0fbec","added_by":"auto","created_at":"2025-03-27 04:29:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":254387,"visible":true,"origin":"","legend":"\u003cp\u003eCardiovascular variables are show by sex\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLeft ventricle mass index\u0026nbsp; and left atrial volume index (A) Significant decrease in left ventricular mass index after three months of follow-up, observing a difference between men and women. (B) Decrease in the volume index of the left atrium, observing more important changes in women at 3 months of greater significance, later it continues to decrease without difference. (C) Improvement of ejection fraction at three months in man and at the end of follow-up the improvement continues without differences. (D) Decreased LV end-diastolic diameters predominantly in men in the first three months. (E) Decrease in the longitudinal diameter of the right ventricle in both men and women with significant difference. (F) Modification of the area of ​​the right atrium with difference between men and women.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5074289/v1/20ca5a8351aeb9f198650f42.png"},{"id":88814147,"identity":"00ca49d8-ba54-4643-9486-7b94c1860732","added_by":"auto","created_at":"2025-08-11 16:07:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1179196,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5074289/v1/c6595a79-9330-4065-842a-6ce6f17818ae.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eSex Differences in Cardiac Remodeling after Kidney Transplantation\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eCardiovascular disease is the most common cause of morbidity and mortality in patients with chronic kidney disease (CKD)(1; 2).\u003c/p\u003e \u003cp\u003eThe heart undergoes adaptive structural changes due to increased work overload known as cardiac remodeling (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe most important manifestation is left ventricle hypertrophy (LVH) cardinal point of uremic cardiomyopathy histologically found the presence of severe myocyte hypertrophy with myocardial disorder and diffuse interstitial fibrosis., another form of presentation is systolic dysfunction (DS) or diastolic dysfunction (DD). At the level of the left atrium there is growth with structural and electrical remodeling as part of uremic cardiomyopathy (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e–\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe hypertrophy of the left ventricle is different according to sex, the response of the heart to pressure overload in women by estrogen-specific B receptors present left ventricular hypertrophy with diastolic dysfunction and in men present eccentric hypertrophy with deterioration of systolic function. Women have a lower degree of apoptosis fibrosis compared to men (\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e–\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe restoration of renal function associated with kidney transplantation (KT) leads to a homeostasis of hormonal, hemodynamic factors that modify the shape and size of the chambers of the heart, causing reverse remodeling of LVH and left atrium with improvement of systolic and diastolic function (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe main objective of the study is to know the changes in LVH, left auricula and diastolic function according to sex after kidney transplantation.\u003c/p\u003e "},{"header":"Material and Method","content":"\u003cp\u003eDesign:\u003c/p\u003e\u003cp\u003eIt was a prospective study with follow-up at 3 and 6 months. The participating patients were sent to the Cardiology service by renal transplant service. The protocol was approved by the ethics and research committee of the Hospital of specialties of the National Medical Center XXI century of the Mexican Institute of Social Security (number R-2016-3601-203 ) were entered into the protocol with prior signature of the informed consent by each participant.\u003c/p\u003e\u003cp\u003eThe study was conducted from February 2018 to January 2020.The participants in the study were patients with chronic kidney disease who met the following inclusion criteria: a) Patient with chronic renal failure of any etiology with previous echocardiogram and with echocardiographic follow-up at 3 and 6 months after living donor kidney transplantation, (b) Any age and sex; c) Patient with CKD with or without replacement therapy undergoing living donor kidney transplantation; d) Patient with CKD who has levels of Hb, Hto, Ca. P, PTH prior to transplantation and after transplantation living donor.\u003c/p\u003e\u003cp\u003eThe exclusion criteria were a) Patient with previous heart disease presenting cardiac hypertrophy or fibrosis, b) previous kidney transplant; c) evidence of cancer, seropositive for hepatitis B, hepatitis C, or HIV.\u003c/p\u003e\u003cp\u003eEchocardiogram:\u003c/p\u003e\u003cp\u003eThe echocardiographic evaluation was performed using the commercially available echocardiogram iEE33 (Phillips Medical System. Andaver. MA) The 2D images, M mode were obtained in a long, short and apical parasternal axis with the patient in the position of left lateral decubitus, the measurements were made according to the recommendations of the American Society of Echocardiography (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe left ventricle mass (LVM) was calculated according to Deveraux's formula, left ventricle hypertrophy was defined if it is equal to or greater than 95 g / m 2 in women and 115g / m\u003csup\u003e2\u003c/sup\u003e in men (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Body surface area was calculated using Mosteller's formula (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Diastolic function was evaluated following the recommendations of the American Society of Echocardiography which considers diastolic dysfunction if it meets 3 or more of the following criteria: Ratio e/e ́\u0026gt; 14m e'septal velocity \u0026lt; 7cm/sec or lateral e'lateral velocity \u0026lt; 10cm/sec, tricuspid regurgitation \u0026gt; 2.8m/sec, volume index to left auricula \u0026gt; 34ml/m\u003csup\u003e2\u003c/sup\u003eb.s. (15).\u003c/p\u003e\u003cp\u003eBiochemical measurements:\u003c/p\u003e\u003cp\u003eA sample of venous blood was obtained from the antecubital vein and taken in the morning after 12hrs of fasting.\u003c/p\u003e\u003cp\u003eThe samples were centrifuged and stored plasma and sounded in aliquots at – 70°C using test tubes.\u003c/p\u003e\u003cp\u003eGlucose, urea, creatinine, albumin, calcium and phosphorus were measured by standard automated method.\u003c/p\u003e\u003ch2\u003eStatistical analysis:\u003c/h2\u003e\u003cp\u003eThe quantitative variables were reported as mean (SD) or median and quatile according to the distribution (25.75 quartiles). Qualitative variables were reported in frequency and percentages.\u003c/p\u003e\u003cp\u003eThe patients were categorized according to sex as well as the follow-up of the echocardiographic parameters. The comparison of the different echocardiographic parameters was performed an analysis of variance of two factors (ANOVA) considering one sex factor and the other the follow-up time. A value of p \u0026lt; 0.05 was considered significant. Data were analyzed using SPSS 22.0 software (IBM Corp. USA).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 51 patients were studied and a living donor kidney transplant was performed with a follow-up at 3 and 6 months respectively.\u003c/p\u003e \u003cp\u003eThere were 19 women and 32 men (mean age 31.16\u0026thinsp;\u0026plusmn;\u0026thinsp;9.83 vs 31.66\u0026thinsp;\u0026plusmn;\u0026thinsp;9.63;p 0.86) years; The cause of renal failure was mainly glomerulonephritis in 23 (45.09%), hypertension 2, diabetic nephropathy 2, other causes in 8 and 16 without knowing the cause and there was no difference between sex. The most frequent co-morbidity found was systemic arterial hypertension in 43 (84.3%) of the total population studied, the most frequent replacement treatment was automated peritoneal dialysis in 21 patients, however there were 4 patients without replacement therapy. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComorbidities, Causes of kidney disease, Dialysis method and pharmacotherapy.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale (n 19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale(n 32)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities :\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension (y/n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15/4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28/4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM (y/n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2/17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.894\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia (y/n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9/10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14/18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking (y/n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4/15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12/20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCausal neprhropathy :\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlomerulonephritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.050*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetic Nephropathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.050*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyalysis method (y/n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17/2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30/2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConservative treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.040*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.040*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemodialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntihypertensive medication (y/n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16/3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.988\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeta-blocker (y/n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2/17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5/29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.690\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACE inhibitors (y/n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2/17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.894\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAngiotensin receptor blockers(y/n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10/9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22/10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.250\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium-channel blockers (y/n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9/10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18/14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e39\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers (y/n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4/15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12/20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAPD, Automated Peritoneal Dialysis: CADP, Continuous Ambulatory Peritoneal Dialysis\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBaseline cardiovascular parameters were observed higher weight, body surface area, as well as systolic and diastolic pressure in men compared to women with significant difference. There was no significant difference between sex in baseline biochemical parameters. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVariables laboratory and cardiovascular at baseline\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale (19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale (32)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e31.16\u0026thinsp;\u0026plusmn;\u0026thinsp;9.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e31.66\u0026thinsp;\u0026plusmn;\u0026thinsp;9.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.860\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kilos)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e57.91\u0026thinsp;\u0026plusmn;\u0026thinsp;11.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e67.54\u0026thinsp;\u0026plusmn;\u0026thinsp;19.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSize (meters)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1. 57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e b.s.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e23.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.604\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody surface (m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e116.37\u0026thinsp;\u0026plusmn;\u0026thinsp;19.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e130.31\u0026thinsp;\u0026plusmn;\u0026thinsp;19.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic pressure (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e76.95\u0026thinsp;\u0026plusmn;\u0026thinsp;10.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e85.06\u0026thinsp;\u0026plusmn;\u0026thinsp;14.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.039*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulse pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e39.42\u0026thinsp;\u0026plusmn;\u0026thinsp;13.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e42.25\u0026thinsp;\u0026plusmn;\u0026thinsp;13.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine\u003c/p\u003e \u003cp\u003eclearance (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e11.36\u0026thinsp;\u0026plusmn;\u0026thinsp;4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.59\u0026thinsp;\u0026plusmn;\u0026thinsp;5.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.399\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrea clearance (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e140.71\u0026thinsp;\u0026plusmn;\u0026thinsp;38.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e131.47\u0026thinsp;\u0026plusmn;\u0026thinsp;55.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e90.68\u0026thinsp;\u0026plusmn;\u0026thinsp;14.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e131.63\u0026thinsp;\u0026plusmn;\u0026thinsp;161.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.279\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb (gr/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.485\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHto (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e31.20\u0026thinsp;\u0026plusmn;\u0026thinsp;5.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e31.71\u0026thinsp;\u0026plusmn;\u0026thinsp;7.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCholesterol (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e173.11\u0026thinsp;\u0026plusmn;\u0026thinsp;38.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e166.99\u0026thinsp;\u0026plusmn;\u0026thinsp;40.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.592\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglycerides (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e165.00\u0026thinsp;\u0026plusmn;\u0026thinsp;86.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e164.96\u0026thinsp;\u0026plusmn;\u0026thinsp;219.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.856\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhosphorus (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.915\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium (mEq/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e137.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e137.62\u0026thinsp;\u0026plusmn;\u0026thinsp;5.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.968\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium (mEq/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.751\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eBMI, body mass index;Hb, Hemoglobin; Hto; Hematocrit\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAnalysis of biochemical and echocardiographic changes during follow-up according to sex.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA significant increase in hemoglobin, albumin, and sodium levels is observed predominantly in men from 3 months to 6 months. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA, \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB, \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eE); Likewise, a significant decrease is observed according to the follow-up in the levels of urea, creatinine, phosphorus, potassium without any difference according to sex. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC, \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD, \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eF, \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eG). The increase in calcium levels was observed in both sexes without significant difference (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eF).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe IMVI there was a difference according to gender at baseline finding higher LVMI in men compared to women (IMVI man 152.94\u0026thinsp;\u0026plusmn;\u0026thinsp;58.24 Vs women 103.89\u0026thinsp;\u0026plusmn;\u0026thinsp;29.94 g / m\u003csup\u003e2\u003c/sup\u003e b.s.; p\u0026thinsp;=\u0026thinsp;0.000) and in the follow-up a significant decrease in IMVI was observed more in men than in women with statistically significant differences. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe left auricula was larger in women at baseline compared to men ( LAVI 45.18\u0026thinsp;\u0026plusmn;\u0026thinsp;29.77 Vs. 29.05\u0026thinsp;\u0026plusmn;\u0026thinsp;9.30 ml / m\u003csup\u003e2\u003c/sup\u003eb.s. ) A reduction in size at the end of follow-up showed a significant difference according to sex p\u0026thinsp;=\u0026thinsp;0.012 and according to follow-up p\u0026thinsp;=\u0026thinsp;0.000. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB)\u003c/p\u003e \u003cp\u003eThe parameters of systolic function there was improvement of the fraction of expulsion in men without significant differences with women in the follow-up (p 0.008). (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC) The diastolic diameters were increased in the baseline state in men which a significant decrease was observed at three months with significant difference and in the end there was no difference. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD).\u003c/p\u003e \u003cp\u003eLV diastolic function was estimated according to the parameters previously described. A total of 38 patients presented at baseline diastolic dysfunction (16 women vs 22 men) at follow-up it was observed that diastolic dysfunction decreased to 30 (9 women and 21 men) (p 0.008).\u003c/p\u003e \u003cp\u003eThe right ventricle its diameters were within normal limits although there was a significant difference according to sex being greater in men in the basal, middle and longitudinal diameters as well as the area of the right auricula with statistically significant differences compared to women. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD,\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eE).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study show significant differences in LVH, systolic and diastolic function according to sex in patients with CKD before transplantation. In addition, a different pattern of reverse remodeling of the left ventricle in patients with CKD after kidney transplantation in men and women was pointed out without previous knowledge of this phenomenon.\u003c/p\u003e \u003cp\u003ePhysiology and cardiovascular diseases are influenced by sex. Among the explanations for these differences, one of the most accepted is the effect of sex steroids. While estrogens have anti-inflammatory and cardioprotective effects in premenopausal women, testosterone has been found to induce abnormal cardiac remodeling in men (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). These characteristics explain why chronic diseases such as hypertension, cardiovascular disease, diabetes, and obesity occur earlier and are more severe in men (18, 19, 20, 21, ). However, lifestyle factors such as unhealthy diets, smoking, alcoholism, and a sedentary lifestyle are more common in men (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and may contribute to the differences. Differences by sex are also noted in CKD patients. Interestingly, women have a higher prevalence of CKD than men (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) but all-cause mortality, particularly cardiovascular mortality, is higher in men (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The effect of sex hormones on the progression of CKD is inconsistent. In an analysis of the CRIC study with almost four thousand patients, there was no difference by sex in the loss of eGFR after adjusting for some variables (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In various studies, CKD progression was faster in men, although it was associated with higher proteinuria (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Some studies have shown higher mortality in women than in men in the population receiving hemodialysis, but the increase in mortality was related to diabetes (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Other studies in the Hemodialysis population have shown contrary data, with more remarkable survival in women than in men.(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The data from the European registry do not show differences in cardiovascular mortality by gender in the dialysis population (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImproving cardiovascular changes after renal transplantation is multifactorial; it includes reducing fluid overload, hemodynamic changes, the elimination of uremic toxins, and decreasing inflammation (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) .\u003c/p\u003e \u003cp\u003eThe reduction of LVH after kidney transplantation is secondary to a significant decrease in fluid overload and uremic toxicity due to the proper functioning of the graft that favors the elimination of intravascular water and, consequently, reduction of the activity of the sympathetic nervous system with the decrease of catecholamines. On the other hand, the calcium by phosphorus product after kidney transplantation is modified, observing a significant decrease in phosphorus and improvement of calcium levels with (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), decrease in parathyroid hormone and secondarily aldosterone levels that favor the decrease of LVH and myocardial fibrosis due to apoptosis as described when performing parathyroidectomy (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). These changes are evident after six months of transplantation due to the recovery of function in both sexes (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe magnitude of LVH reduction is variable (\u003cspan additionalcitationids=\"CR38 CR39 CR40 CR41\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Iqbal et al. reported that in 22 patients, the most significant decrease in LVMI was 131g/m2 at a 3-month follow-up(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). However, there are studies whit no significant changes in the LVMI (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) In all these studies, difference by sex was not reported. In our study, men had a reduction in LVMI of 36.68g/m2 of surface area at six months, more considerable than observed in women, which was 17.87g/m2 (p 0.000). The reduction in LVMI is lower than that reported by Iqbal et al. since LVMI at baseline was 379g/m2 in their population, more extensive compared to our population, where the IMV did not was so important.\u003c/p\u003e \u003cp\u003eThe ejection fraction is a parameter to assess systolic function. It is reported in the literature that there are changes in ejection fraction after transplantation when evaluation is performed by echocardiography and magnetic resonance imaging. Deng et al. (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) reported that in 48 patients with baseline EF from 40 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) %, it increased to 60 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) %; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In our study EF was within normal limits from baseline; however, it was higher in women (64.47(7.23) vs. men 54.54(11.53), and an additional improvement was observed in the male group (FE 61.57(9.98; p 0.008) during follow-up.\u003c/p\u003e \u003cp\u003ePost-transplant left ventricular end-diastolic diameters (LVDD) decreased, probably secondary to reduced intravascular volume and blood pressure, lower angiotensin levels, and sympathetic activity. There are controversial studies in this regard. Non-significant differences were found in some reports; however, when the evaluation was done with magnetic resonance, they became significant (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). In the post-transplant follow-up, we found a decrease in it, being more evident in men (initial LVDD from 48.47 (8.79) decreased to 41.80 (7.74), p 0.007).\u003c/p\u003e \u003cp\u003eZapolski et al. (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e) reported a decrease in the hemodynamic indices of the left auricula at three and six months of post-renal transplant follow-up. LAVI is a marker of diastolic dysfunction and remodeling. It changed secondary to improvement in diastolic function after transplantation (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, we observed that LAVI at baseline was higher in women than in men 81(29.87) Vs. 29.05(9.30ml/m2) with more significant diastolic dysfunction in women. During follow-up, the decrease in LAVI was more significant at three months. At the end of the follow-up, it was within normal limits.\u003c/p\u003e \u003cp\u003eInsufficiency-type dysfunction is the most common finding in the heart valves. It improves after transplantation, as was previously reported in a study in 59 valves; the order of frequency of the valves affected was: tricuspid 28, mitral 21, aortic 5, and pulmonary 4, respectively. At the end of the follow-up, it decreased to 40. The most frequent were mitral and tricuspid (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecently, a close interaction of sex hormones with intestinal microbiota on CKD patients' cardiovascular system deterioration has been described. The effect on cardiac architecture is more accentuated in men than women (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e) and is related to disturbances of extracellular matrix homeostasis. Gut microbiota seems to have participation in posttransplant outcomes; however, its specific effects on cardiovascular changes after transplantation are not known (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe most important findings of our study are the difference in reverse change of heart remodelation according to sex in patients with CKD after kidney transplantation. At baseline, a lower degree of LVH but more significant diastolic dysfunction and dilation of the left atrium were seen in women. After transplantation, remodeling of the left atrium was also more significant in women. In contrast, reverse remodeling of the left ventricle with decreased LVMI, diastolic diameters, and improvement of EF was more significant in men.\u003c/p\u003e \u003cp\u003eOur study has some limitations. The follow-up was limited to early changes; more evident results could be obtained with a follow-up longer than 24 months. However, due to the pandemic, it was burdensome to follow up with patients due to the risk of infection during the cardiological assessment. Likewise, another limitation is the follow-up of cardiac remodeling only by echocardiography. Ideally, MRI study with gadolinium should be used; however, subjecting post-transplant patients to this type of study has the risk of toxicity, causing undesirable graft dysfunction, which is why it is not recommended at least a specific indication by heart disease.\u003c/p\u003e \u003cp\u003eIn conclusion, we found differences in inverse remodeling of the heart of post-transplanted patients according to their sex. This included hypertrophy of the left ventricle and the left auricula with the decrease of the IMVI, the size of the left atrium, and modification of the diastolic function.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eLVH. \u0026nbsp; \u0026nbsp; \u0026nbsp;Left Ventricular Hypertrophy\u003c/p\u003e\n\u003cp\u003eKT \u0026nbsp; \u0026nbsp; \u0026nbsp; Kidney \u0026nbsp;Transplantation\u003c/p\u003e\n\u003cp\u003eLVMI \u0026nbsp; Left Ventricular Mass Index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLAVI \u0026nbsp; \u0026nbsp;Left Atrial Volumen Index\u003c/p\u003e\n\u003cp\u003eCKD \u0026nbsp; \u0026nbsp;Chronic Kidney Disease\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Systolic Dysfunction \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDD. \u0026nbsp; \u0026nbsp; \u0026nbsp;Diastolic Dysfunction\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePTH \u0026nbsp; \u0026nbsp; Parathyroid Hormone\u003c/p\u003e\n\u003cp\u003eHIV \u0026nbsp; \u0026nbsp; \u0026nbsp;Human immunodeficiency virus\u003c/p\u003e\n\u003cp\u003eSD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Standart Deviation\u003c/p\u003e\n\u003cp\u003eANOVA \u0026nbsp;Analysis of Variance\u003c/p\u003e\n\u003cp\u003eGFR \u0026nbsp; \u0026nbsp; \u0026nbsp; Glomerular Filtration Rate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEF \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Ejection Fraction \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLVDD \u0026nbsp; \u0026nbsp;Left Ventricular Diastolic Diameters\u003c/p\u003e\n\u003cp\u003eMRI \u0026nbsp; \u0026nbsp; \u0026nbsp; Magnetic Resonance \u0026nbsp;Image\u003c/p\u003e\n\u003cp\u003eAPD \u0026nbsp; \u0026nbsp; \u0026nbsp;Automated Peritoneal Dialysis\u003c/p\u003e\n\u003cp\u003eCAPD \u0026nbsp; \u0026nbsp; Continuous Ambulatory Peritoneal Dialysis\u003c/p\u003e\n\u003cp\u003eBMI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Body Mass Index\u003c/p\u003e\n\u003cp\u003eHb \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Hemoglobin\u003c/p\u003e\n\u003cp\u003eHto. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Hematocrit\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements : The authors would like to thank the electrocardiograph technician and the nursing staff for their support in carrying out this study. \u003c/p\u003e\n\u003cp\u003eAuthor Contributions : OOR, HCR and RPS conceived the study. OOR, CBM. IMG, RGL, and IQO examined patients and collected patient data. OOR, HCR, REP, JCL and RPS did data analyses. OOR did the statistical analysis. OOR, and RPS wrote the first draft.RPS and OOR revised the manuscript providing critical inputs. AS finalized the manuscript. All authors reviewed and agreed on the finalized manuscript.\u003c/p\u003e\n\u003cp\u003eFunding The authors did not receive any type of funding for this study. \u003c/p\u003e\n\u003cp\u003eAvailable of Data and Materials : \u003c/p\u003e\n\u003cp\u003eThe data may be made on a reasonable request. \u003c/p\u003e\n\n\u003cp\u003eConflict of Interest None.\u003c/p\u003e\n\u003cp\u003eEthical Approval and Consent to Participate : The protocol was approved by the ethics in accordance with the Declaration of Helsinki and research committee of the Hospital of specialties of the National Medical Center XXI century of the Mexican Institute of Social Security (number R-2016-3601-203 ) were entered into the protocol with prior signature of the informed consent by each participant. \u003c/p\u003e\n\n\n\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKoo TY, Ahn C, Yang J..Renal Allograft Function Is a Risk Factor of Left Ventricular Remodeling After Kidney Transplantation., Transplant Proc. 2017;49(5): 1043-1047. doi: 10.1016/j.transproceed.2017.03.052.\u003c/li\u003e\n\u003cli\u003eNael Hawwa, Kevin Shrestha, Muhammad Hammadah, et al.. 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Epub 2019 Aug 10.\u003c/li\u003e\n\u003cli\u003eCarrero JJ, de Mutsert R, Axelsson J, et al NECOSAD Study Group. Sex differences in the impact of diabetes on mortality in chronic dialysis patients. 1, 2011, Nephrol Dial Transplant 2011; 26 (1): 270-6. doi: 10.1093/ndt/gfq386.Epub 2010 Jul 9.\u003c/li\u003e\n\u003cli\u003eTsujikawa H, Yamada S, Hiyamuta H, et al . Sex differences in the 10-year survival of patients undergoing maintenance hemodialysis in the Q-Cohort Study. Sci Rep 2022 J; 12(1):345. doi: 10.1038/s41598-021-03551-x. \u003c/li\u003e\n\u003cli\u003eCarrero JJ, de Jager DJ, Verduijn M,et al . Cardiovascular and noncardiovascular mortality among men and women starting dialysis. Clin J Am Soc Nephrol 2011; 6(7): 1722-30. doi: 10.2215/CJN.11331210.PMID: 21734088\u003c/li\u003e\n\u003cli\u003eHewing B, Dehn AM, Staeck O, et al.Improved Left Ventricular Structure and Function After Successful Kidney Transplantation. Kidney Blood Press Res 2016;41(15): 701-709. doi: 10.1159/000450559.\u003c/li\u003e\n\u003cli\u003eGallardo JM, Prado-Uribe MC, Amato D, et Inflammation and Oxidative Stress Markers by Pentoxifylline Treatment in Rats with Chronic Renal Failure and High Sodium Intake. al. Arch Med Res 2007;38(1):34-38. doi: 10.1016/j.arcmed.2006.08.010.\u003c/li\u003e\n\u003cli\u003ePetrov, P. Lijnen and V. Renin-Angiotensin System, Hypertrophy and Gene Expression in Cardiac Myocytes. J Mol Cell Cardiol 1999;31(5):949-970. doi: 10.1006/jmcc.1999.0934.\u003c/li\u003e\n\u003cli\u003eMej\u0026iacute;a-Rodr\u0026iacute;guez O, Herrera-Abarca JE, Ceballos-Reyes G, et al. Cardiovascular and RenalEffects of Bromocriptine in Diabetic Patients with Stage. 4 Chronic Kidney Disease. Biomed Res Int 2013;2013:104059. doi: 10.1155/2013/104059.\u003c/li\u003e\n\u003cli\u003eRodríguez-Ayala R Ávila-Díaz M, Foyo-Niembro E, et al. 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S De Castro , G Migliau, P Giannantoni, et al. Persistence of abnormal left ventricular filling following renal transplantation. Transplant Proc, 1993;25(4): 2603-4.\u003c/li\u003e\n\u003cli\u003eYan Deng , Anil Pandit , Raymond L Heilman, et al. Left ventricular torsion changes post kidney transplantation. J Cardiovasc Ultrasound 2013;21(4):171-176. doi: 10.4250/jcu.2013.21.4.171.\u003c/li\u003e\n\u003cli\u003eSoraia R C Ferreira , Valdir A Mois\u0026eacute;s, Agostinho Tavares, et al.Cardiovascular effects of successful renal transplantation: a 1-year sequential study of left ventricular morphology and function, and 24-hour blood pressure profile. Transplantation 2002;74(11): 1580-1587. doi: 10.1097/00007890-200212150-00016.\u003c/li\u003e\n\u003cli\u003eSahand Hamidi , Javad Kojuri , Armin Attar,et al.The effect of kidney transplantation on speckled tracking echocardiography findings in patients on hemodialysis. J Cardiovasc Thorac Res 2018;10(2): 90-94. doi: 10.15171/jcvtr.2018.14.\u003c/li\u003e\n\u003cli\u003eBernd Hewing , Anna Maria Dehn, Oliver Staeck, et al Improved Left Ventricular Structure and Function After Successful Kidney Transplantation. Kidney Blood Press Res 2016;41(5): 701-709. doi: 10.1159/000450559.\u003c/li\u003e\n\u003cli\u003eqbal MM, Rashid HU, Banerjee SK, et al. Changes in cardiac parameters of renal allograft recipients: a compilation of clinical, laboratory, and echocardiographic observations., Transplant Proc 2008;40(7): 2327-2329. doi: 10.1016/j.transproceed.2008.07.099.\u003c/li\u003e\n\u003cli\u003eStewart GA, Foster J, Cowan M, et al. Echocardiography overesti-mates left ventricular mass in hemodial-ysis patients relative to magneticresonance imaging. Kidney Int 1999; 256(6):248 - 2253. doi: 10.1046/j.1523-1755.1999.00786.x.\u003c/li\u003e\n\u003cli\u003eHawwa N, Schreiber MJ Jr, Tang WH Pharmacologic management of chronic reno-cardiac syndrome.. Curr Heart Fail Rep 2013;10(1): 54-62. doi: 10.1007/s11897-012-0122-8.\u003c/li\u003e\n\u003cli\u003eDeng Y, Pandit A, Heilman RL, et al.Left ventricular torsion changes post kidney transplantation. J Cardiovasc Ultrasound 2013;21(4): 171-176. doi: 10.4250/jcu.2013.21.4.171.\u003c/li\u003e\n\u003cli\u003eZapolski T, Furmaga J, Wysokiński AP, et al.The atrial uremic cardiomyopathy regression in patients after kidney transplantation - the prospective echocardiographic study. BMC Nephrology 2019;20(1): 152. doi: 10.1186/s12882-019-1333-y.\u003c/li\u003e\n\u003cli\u003eMats Christian H\u0026oslash;jbjerg Lassen, Atif Qasim , Allison Webber , et al.The effect of kidney transplantation on left ventricular remodeling and global diastolic strain rate in end-stage renal disease. Echocardiography 2021;38(11); 1879-1886. doi: 10.1111/echo.15226.\u003c/li\u003e\n\u003cli\u003eMelchor JL, Gracida C, Orihuela O. Improvement of Mitral Dysfunction After Kidney Transplantation. Transplant Proc 2002;34(1): 396-397. doi: 10.1016/s0041-1345(01)02837-8.\u003c/li\u003e\n\u003cli\u003eGarcia-Covarrubias L, Hern\u0026aacute;ndez K, Castro I, Hinojosa H, Molina L, et al.Cardiac Remodeling in Structure and Function Six Months After Kidney. Transplat Proc 2018;50(2): 254-257. doi: 10.1016/j.transproceed.2017.12.038.\u003c/li\u003e\n\u003cli\u003eKararigas S, Li G . Role of Biological Sex in the Cardiovascular-Gut Microbiome Axis. Front Cardiovascular Med 2022;3: 759735. doi: 10.3389/fcvm.2021.759735\u003c/li\u003e\n\u003cli\u003eWinichakoon P, Chaiwarith R, Chattipakorn N, Chattipakorn SC. Impact of gut microbiota on kidney transplantation. Transplant Rev (Orlando). 2022 ;36(1):100668. doi: 10.1016/j.trre.2021.100668.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sex differences, Cardiac remodeling, Kidney transplant","lastPublishedDoi":"10.21203/rs.3.rs-5074289/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5074289/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Cardiovascular diseases are the most frequent causes of death in patients with chronic kidney disease.\u0026nbsp; Patients with chronic kidney disease \u0026nbsp;have heart remodeling manifested by left ventricular hypertrophy\u0026nbsp; \u0026nbsp;, left atrial enlargement,\u0026nbsp; diastolic and systolic dysfunction. After kidney\u0026nbsp; transplantation\u0026nbsp; there is reverse remodeling of the changes. Male and female hormones modify this remodeling. The aim of the study\u0026nbsp; is to know the remodeling changes of the heart after kidney\u0026nbsp;\u0026nbsp; transplant according to the sex.\u003c/p\u003e\n\u003cp\u003eMethods: A prospective study was carried out with follow-up at 3 and 6 months, included\u0026nbsp;\u0026nbsp; patients in the kidney transplant \u0026nbsp;protocol sent to the Cardiology service to those who underwent an echocardiogram and laboratory shots before the kidney transplantation\u0026nbsp; and after 3 and 6 months. Statistical analysis: The patients were categorized according to sex as well as the follow-up of the echocardiographic parameters . The comparison of the different echocardiographic parameters was performed an analysis of variance of two factors (ANOVA) considering one sex factor and the other the follow-up time. A value of p\u0026lt; 0.05 was considered significant.\u003c/p\u003e\n\u003cp\u003eResults: A total of 51 patients were studied, 19 women and 32 men (mean age of 31.16±9.83 vs 31.66± 9.63); p 0.86) years.\u0026nbsp; The Left ventricular\u0026nbsp; hypertrophy showed differences according to sex from baseline being higher in men with\u0026nbsp; left ventricular mass index (LVMI)\u0026nbsp; compared to women ( male 152.94±58.24 Vs women 103.89±29.94 g /m\u003csup\u003e2 \u003c/sup\u003e.; p=0.000) and at follow-up men presented a greater reduction in LVMI compared to women (p=0.000). The left atrial volume index\u0026nbsp; was found to be langer at baseline in women compared to men (LAVI 45.18±29.77 Vs. 29.05± 9.30ml/m\u003csup\u003e2\u003c/sup\u003e.;p=0.028) at follow-up the size reduction was significantly greater in women (p = 0.012 and according to follow-up p = 0.000).\u003c/p\u003e\n\u003cp\u003eConclusion: If there is a difference in remodeling , it reverses according to sex in the echocardiographic parameters.\u003c/p\u003e","manuscriptTitle":"Sex Differences in Cardiac Remodeling after Kidney Transplantation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-27 04:29:06","doi":"10.21203/rs.3.rs-5074289/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-18T05:52:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-17T23:19:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-16T15:20:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-06T17:59:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-02T20:09:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15330203187948428727510701789124403985","date":"2024-11-02T19:00:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"111771617161664808262197397443665305247","date":"2024-10-29T06:14:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"24691676760604052880145420360609363161","date":"2024-10-27T22:23:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181827482196347016558342841463009961625","date":"2024-10-27T05:29:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235412431433897250831123733483997585151","date":"2024-10-27T03:22:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-27T03:13:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-10-01T13:19:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-01T06:14:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-01T06:11:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2024-09-12T02:54:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"12d27d60-07cc-4cd1-af08-16b4fac8fb31","owner":[],"postedDate":"March 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-11T16:01:36+00:00","versionOfRecord":{"articleIdentity":"rs-5074289","link":"https://doi.org/10.1186/s12882-025-04313-x","journal":{"identity":"bmc-nephrology","isVorOnly":false,"title":"BMC Nephrology"},"publishedOn":"2025-08-06 15:56:52","publishedOnDateReadable":"August 6th, 2025"},"versionCreatedAt":"2025-03-27 04:29:06","video":"","vorDoi":"10.1186/s12882-025-04313-x","vorDoiUrl":"https://doi.org/10.1186/s12882-025-04313-x","workflowStages":[]},"version":"v1","identity":"rs-5074289","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5074289","identity":"rs-5074289","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}